Pharmacy Practice in China

Yu Fang, in Pharmacy Practice in Developing Countries, 2016

7.3 Community pharmacies
Community pharmacies are becoming increasingly recognized in
many parts of the world as a source of professional medical
advice.35,36 This is also occurring in China, where community
pharmacies have emerged as a source of primary health care.37 To
establish and operate a pharmacy in China, the number of permanent
residents, terrain, transportation, and practical needs of the locality
must be taken into consideration. According to the Provisions for
Supervision of Drug Distribution adopted by the CFDA in 2006,
ownership of a pharmacy is not restricted to pharmacists,38 provided
that a pharmaceutical professional is present when medications are
distributed and pharmaceutical care services are offered.39 The
Drug Administration Law of the People’s Republic of China, revised in
2001, stipulates that community pharmacies must have legally
qualified pharmaceutical professionals, including pharmacists and
pharmacy technicians. This law is not strictly enforced, however, and
most pharmacies sell medications without the presence of a
pharmaceutical professional. As a result, rules concerning the
operation and ownership of community pharmacies were tightened in
early 2012. According to this 12th Five-Year Plan on Drug Safety
released by the State Council,40 newly opened community pharmacies
must be staffed by licensed pharmacists during business hours to
ensure the quality of medications and services. Also, by 2015, all
community pharmacies must be owned by licensed pharmacists.
After the latest round of health care reforms in 2009, community
pharmacies have come to play a significantly more important role in
China. In 2009, the number of community pharmacies reached nearly
388,000, a 6.1% increase from the previous year. This increase was
primarily a result of the establishment of pharmacy chains, which
accounted for 35% of pharmacies in 2009, while the number of
independent pharmacies decreased.22 Each community pharmacy in
China caters to an average of 3532 people. In contrast, the number of
licensed pharmacists was only 185,692 in 2010, equivalent to
approximately 7380 people per licensed pharmacist, which is much
higher than in the United States, Canada, and other developed
countries.41–43 There is a lack of pharmacists in China. This shortage is
worse in rural areas, which suffer from chronic understaffing in both
the hospital and community pharmacy sectors. In 2010, a total of
388,000 pharmacists (licensed pharmacists and pharmaceutical
specialists) were working in a variety of settings. This number
translates to approximately 0.29 pharmacists per 1000 people, lower
than that in India and Brazil.18 A community pharmacist must register
in a provincial pharmacists’ association to work. Two professional
societies represent all Chinese pharmacists in community pharmacies:
the Chinese Pharmaceutical Association (CPA; run by the Ministry of
Civil Affairs) and the China Licensed Pharmacist Association (run by
the CFDA).
Community pharmacies are a profitable business in China. From 1978
until 2009, the average annual medication sales growth in China was
20%, reaching USD 21.8 billion in 2009.22 Hospitals, however, remain
the main outlets for medication distribution in China, with more than
19,000 hospital pharmacies accounting for 74% of the total medication
sales in 2009.14 This situation is changing because the government is
encouraging the establishment of community pharmacies that are not
associated with hospitals. Unlike many developed countries, no official
data on community pharmacist salaries are available because of the
lack of a national survey of Chinese pharmacists.
Both prescription and nonprescription medicines can be sold in
community pharmacies, with the exception of narcotic drugs,
some psychotropic substances, abortion drugs, anabolic
steroids, peptide hormones, chemical products used in the production
of narcotics, radiopharmaceuticals, and vaccines. These products can
be prescribed and dispensed only in designated medical institutions.
Current regulations state that prescription medications cannot be
sold without a medical prescription.44 Because of the shortage of
pharmacists and the profit-driven behavior of some retailers, the illegal
sale of prescription medications (e.g., antibiotics) is common in China,
especially in rural areas.45